Brindis R G, Brundage B H, Ullyot D J, McKay C W, Lipton M J, Turley K
J Am Coll Cardiol. 1984 Jan;3(1):55-62. doi: 10.1016/s0735-1097(84)80430-1.
Coronary artery bypass graft patency was examined by contrast-enhanced computed tomography in 18 patients with perioperative myocardial infarction soon after surgery to determine the role of graft occlusion. Preoperative coronary angiograms were reviewed to assess native coronary disease and visible collateral channels in the distribution of the myocardial infarction. Perioperative myocardial infarction was diagnosed if creatine kinase-MB was elevated, characteristic electrocardiographic changes occurred and, in the majority of cases, the pyrophosphate scan was positive. Fourteen patients (78%) had patent grafts and perioperative myocardial infarction in the distribution of the grafted vessel. Four patients had an occluded graft with infarction in the distribution of the grafted vessel. Among the 14 patients with patent grafts, there was a significant difference (p less than 0.0005) in the degree of the mean (+/- standard deviation) diameter stenosis of 80 +/- 11% in native coronary vessels supplying the perioperatively infarcted myocardium versus a 55 +/- 12% mean diameter stenosis in the 23 bypassed native coronary vessels supplying noninfarcted myocardium. It is concluded that the majority of perioperative myocardial infarcts associated with coronary artery bypass operations are not caused by graft occlusion. The severity of coronary obstruction in the grafted vessel and the lack of collateral vessels to the region of perioperative infarction in patients with patent grafts suggests that an island of jeopardized myocardium exists that is subject to inadequate intraoperative preservation.
在18例术后不久发生围手术期心肌梗死的患者中，通过对比增强计算机断层扫描检查冠状动脉搭桥移植物的通畅情况，以确定移植物闭塞的作用。回顾术前冠状动脉造影，以评估原发病变冠状动脉疾病以及心肌梗死区域内可见的侧支血管。如果肌酸激酶-MB升高、出现特征性心电图改变，并且在大多数情况下焦磷酸盐扫描呈阳性，则诊断为围手术期心肌梗死。14例患者（78%）的移植物通畅，且在移植血管分布区域发生围手术期心肌梗死。4例患者的移植物闭塞，且在移植血管分布区域发生梗死。在14例移植物通畅的患者中，供应围手术期梗死心肌的原发病变冠状动脉血管的平均（±标准差）直径狭窄程度为80±11%，与供应未梗死心肌的23条旁路移植的原发病变冠状动脉血管的平均直径狭窄程度55±12%相比，存在显著差异（p<0.0005）。得出的结论是，与冠状动脉搭桥手术相关的大多数围手术期心肌梗死并非由移植物闭塞引起。移植血管中冠状动脉阻塞的严重程度以及移植物通畅的患者围手术期梗死区域缺乏侧支血管，提示存在一个心肌危险岛，其在术中未得到充分保护。
